中文簡短式智能評估與盧-尼神經心理測驗組篩檢測驗於腦血管意外疾患之適用性探討

王鼎嘉

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中文簡短式智能評估與盧-尼神經心理測驗組篩檢測驗於腦血管意外疾患之適用性探討

An evaluation of Chinese version of mini-mental state examination and Luria-Nebraska neuropsychological battery screening test for patient with cerebral vascular accident

王鼎嘉 , Masters　　Advisor：郭乃文　　Co-advisor ：蘇五洲

繁體中文

簡短式智能評估；盧-尼神經心理測驗組篩檢測驗；神經心理衡鑑；腦血管意外； MMSE ； LNNB-S ； neuropsychological assessment ； cerebral vascular accident

Abstract │ Reference (123) │ Altmetrics

Abstract 〈TOP〉

目的：
認知功能缺損為腦血管意外(cerebral vascular accident, CVA)疾患常伴隨之症狀，故臨床上應發展適用之篩檢測驗。中文簡短式智能評估(Mini-Mental Status Examination-Chinese, MMSE-C)與盧-尼神經心理測驗組篩檢測驗(Luria-Nebraska Neuropsychological Battery-Screening test, LNNB-S)為兩項廣泛被使用之神經認知功能缺損的篩檢測驗。國內過去較少有針對認知篩檢測驗適用性之研究，故本研究目的有二：(1)檢視MMSE-C與LNNB-S於CVA患者之篩檢力。(2)探討MMSE-C與LNNB-S於不同CVA腦區受損之篩檢效力。

方法：
本研究為回溯性研究，病歷資料來自南部某醫學中心復健科自2005至2014年之CVA患者，篩檢條件為確診僅具CVA診斷且因臨床需求完成MMSE-C與LNNB-S之病患共158人(男125人、女33人，平均年齡52.6 ± 13.4歲，平均教育年數10.5 ± 4.1年)。將所有病歷資料依腦部受損區域分為四組：左腦受損(32人)、右腦受損(37人)、雙側腦受損(46人)、多重腦區受損(43人)，並以單因子變異數分析、共變數分析、卡方檢定分析之。

結果：
(1) 資料顯示20.3%於MMSE-C與LNNB-S均呈現陰性，或許源於其認知功能受CVA影響不大。(2)MMSE-C檢出認知功能不足之比率為44.9%；LNNB-S檢出77.9%。被MMSE-C檢出陽性者，同時有95.8%可被LNNB-S檢出；被LNNB-S檢出陽性者，僅有55.3%同時被MMSE-C檢出；於MMSE-C陰性者，在右腦傷組達64.9%為最高。(3) 四組於MMSE-C得分皆低於正常組常模，其中左腦、雙側、多重腦區受損等三組於MMSE-C總分、地點定向、回憶、語言之表現皆顯著低於右腦受損組。 (4)四組於LNNB-S受損分數皆遠高於正常組常模，左腦受損組於數字概念與高等認知兩個因素之受損分數顯著高於其他三組。

結論：
運用界斷分數時，MMSE-C對於CVA患者之檢出率較低，尤其對於右腦傷患者檢出比率最低，推測是因測驗內容大量涉及語文功能之故。MMSE-C受到天花板效應之影響，對於CVA患者而言整體偏易，故不宜單獨作為CVA患者之篩檢測驗。運用LNNB-S的臨界分數，可檢出CVA患者之異常。因此臨床工作者在使用MMSE-C後，建議加做LNNB-S可提高神經認知功能缺損之檢出率。

Parallel Abstract 〈TOP〉

Patients with cerebrovascular accident (CVA) often experience neurocognitive impairment; thus, an effective screening test should be developed. The Mini-Mental Status Examination-Chinese (MMSE-C) and the Luria-Nebraska Neuropsychological Battery-Screening test (LNNB-S) are two commonly used tests for assessing cognitive impairment. In the present study, we examined the assessment effectiveness of the MMSE-C and LNNB-S and compared them regarding their assessment effectiveness for impairment in various CVA brain regions. This study was a retrospective study. Medical records from the 2005–2014 period for patients with CVA at the rehabilitation division at a medical center in Southern Taiwan were used. A total of 158 patients diagnosed with CVA and who had completed the MMSE-C and LNNB-S tests were enrolled in this study. When cutoff points 23/24 were used to screen patients with CVA, the detection rate of the MMSE-C test was low particularly for patients with right-brain impairment. The reason may be that the test involves verbal function. Because of the ceiling effect, the MMSE-C test was not a challenge for patients with CVA; thus, the MMSE-C test should not be used alone to diagnose patients’ condition for CVA. The cutoff point for the LNNB-S test can be used to test for abnormalities in patients with CVA. Therefore, we suggest that after using the MMSE-C test, medical professionals should use the LNNB-S test to enhance accuracy in the test for impaired neurocognitive function.

Reference ( 123 ) 〈TOP〉

郭乃文、劉秀枝、王珮芳、廖光淦、甄瑞興、林恭平等人 (1988)。簡短式智能評估之中文施測與常模建立。中華民國復健醫學會雜誌。16，52-59。
連結：
余麗樺、郭乃文 (1998)。盧-尼神經心理測驗組篩檢測驗在台灣地區適用性之探討。高雄醫學科學雜誌。14，779-790。
連結：
郭乃文、余麗樺、潘秀琴、吳玉欣、林亭宇 (1999)。盧－尼神經心理測驗組之中文修訂與常模建立研究。中華民國復健醫學會雜誌，27(2)，47-55.
連結：
Adams, H. P., Bendixen, B. H., Kappelle, L. J., Biller, J., Love, B. B., Gordon, D. L., & Marsh, E. (1993). Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke, 24(1), 35-41.
連結：
Adams, R. L., Boake, C., & Crain, C. (1982). Bias in a neuropsychological test classification related to education, age, and ethnicity. Journal of consulting and clinical psychology, 50(1), 143.
連結：

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